Provider Demographics
NPI:1497323901
Name:COLLIN KWASNIK, DDS, INC.
Entity Type:Organization
Organization Name:COLLIN KWASNIK, DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:COLLIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KWASNIK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:802-272-4498
Mailing Address - Street 1:395 PAINE TPKE N
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:VT
Mailing Address - Zip Code:05602-9157
Mailing Address - Country:US
Mailing Address - Phone:802-229-0561
Mailing Address - Fax:
Practice Address - Street 1:395 PAINE TPKE N
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:VT
Practice Address - Zip Code:05602-9157
Practice Address - Country:US
Practice Address - Phone:802-229-0561
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-12
Last Update Date:2021-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental